Deutsche medizinische Wochenschrift
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Membranous nephropathy is an autoimmune disease caused in most cases by binding of circulating antibodies to antigens on podocytes. PLA2R1 and THSD7A have been identified as target antigens in 70-80 % and 2-3 % of patients, respectively. The detection of PLA2R1- and THSD7A-antibodies in the blood and staining of renal biopsies for the respective antigens allow the correct diagnosis of PLA2R1- and THSD7A-associated membranous nephropathy, respectively, in practically 100 % of cases. ⋯ Rituximab was shown to be non-inferior to ciclosporine A to induce remission of proteinuria after 12 months. After 24 months rituximab was superior to ciclosporine A for the same endpoint. Development of novel treatment strategies, focusing on disease pathogenesis, remains highly relevant for these patients.
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Dtsch. Med. Wochenschr. · Oct 2020
[Non-functioning pituitary tumors - short presentation of the first German guideline].
Pituitary tumors are frequent (estimated prevalence in adults up to 10 %). However, diagnostic work-up and therapeutic concepts are not well standardized; especially for non-functioning tumors. In the beginning of 2020, the first German interdisciplinary guideline on these topics was published. ⋯ If the surgical resection was incomplete or if tumors are recurrent, therapeutic modalities (e. g. re-operation, radiotherapy, observation) should be interdisciplinary considered. In all patients with or without therapeutic intervention, long-term follow-up is required. Patient with larger pituitary tumors or former surgery/radiotherapy should be regularly counseled regarding potential symptoms of hormonal insufficiency.
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Dtsch. Med. Wochenschr. · Oct 2020
[How complete is the Germany-wide standardised medication list ("Bundeseinheitlicher Medikationsplan")? An analysis at hospital admission.]
At inpatient admission, the timeliness and completeness of the Germany-wide standardised medication list ("Bundeseinheitlicher Medikationsplan") often seems inappropriate. It is also unclear which characteristics of the lists increase the probability of discrepancies. ⋯ The timeliness, completeness and aspects of patient safety must be comprehensively validated. Medication lists that are older than 1 month should be checked particularly critically with regard to information on strength and dosage and the plan should be updated accordingly at regular intervals.
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Dtsch. Med. Wochenschr. · Oct 2020
[Abdominal Emergencies in The View of an Intensivist - Intra-abdominal Hypertension and Abdominal Compartment Syndrome].
In critically ill patients an intra-abdominal hypertension is a common phenomenon. An IAH is defined as an IAP persistent ≥ 12 mmHg, an abdominal compartment syndrome is defined as an IAP persistent ≥ 20 mmHg in combination with new organ failure. ⋯ The bladder pressure should be measured in a standardized manner. The therapy of IAH should be individualized.